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Although audiovisual (AV) training has been shown to improve overall speech perception in hearing-impaired listeners, there has been a lack of direct brain imaging data to help elucidate the neural networks and neural plasticity associated with hearing aid (HA) use and auditory training targeting speechreading. For this purpose, the current clinical case study reports functional magnetic resonance imaging (fMRI) data from two hearing-impaired patients who were first-time HA users. During the study period, both patients used HAs for 8 weeks; only one received a training program named ReadMyQuips™ (RMQ) targeting speechreading during the second half of the study period for 4 weeks. Identical fMRI tests were administered at pre-fitting and at the end of the 8 weeks. Regions of interest (ROI) including auditory cortex and visual cortex for uni-sensory processing, and superior temporal sulcus (STS) for AV integration, were identified for each person through independent functional localizer task. The results showed experience-dependent changes involving ROIs of auditory cortex, STS and functional connectivity between uni-sensory ROIs and STS from pretest to posttest in both cases. These data provide initial evidence for the malleable experience-driven cortical functionality for AV speech perception in elderly hearing-impaired people and call for further studies with a much larger subject sample and systematic control to fill in the knowledge gap to understand brain plasticity associated with auditory rehabilitation in the aging population. [ABSTRACT FROM AUTHOR]

Importance: The already large population of individuals with age- or noise-related hearing loss in the United States is increasing, yet hearing aids remain largely inaccessible. The recent decision by the US Food and Drug Administration to not enforce the medical examination prior to hearing aid fitting highlights the need to reengineer consumer protections when increasing accessibility. A self-administered tool to estimate ear disease risk would provide disease surveillance without posing an unreasonable barrier to hearing aid procurement., Objective: To develop and validate a consumer questionnaire for the self-assessment of risk for ear diseases associated with hearing loss., Design, Setting, and Participants: The questionnaire was developed using established methods including expert opinion to validate and create questions, and cognitive interviews to ensure that questions were clear to respondents. Exploratory structural equation modeling, logistic regression, and receiver operating characteristic curve analysis were used to determine sensitivity and specificity with blinded neurotologist opinion as the criterion for evaluation. Patients 40 to 80 years old with ear or hearing complaints necessitating a neurotologic examination and a control group of participants with a diagnosis of age- or noise-related hearing loss participated at the Departments of Otorhinolaryngology and Audiology of Mayo Clinic Florida., Main Outcomes and Measures: Sensitivity and specificity of the prototype questionnaire to identify individuals with targeted diseases., Results: Of 307 participants (mean [SD] age, 62.9 [9.8] years; 148 [48%] female), 75% (n = 231) were enrolled with targeted disease(s) identified on neurotologic assessment and 25% (n = 76) with age- or noise-related hearing loss. Participants were randomly divided into a training sample (80% [n = 246; 185 with disease, 61 controls]) and a test sample (20% [n = 61; 46 with disease, 15 controls]). Using a simple scoring method, a sensitivity of 94% (95% CI, 89%-97%) and specificity of 61% (95% CI, 47%-73%) were established in the training sample. Applying this cutoff to the test sample resulted in 85% (95% CI, 71%-93%) sensitivity and 47% (95% CI, 22%-73%) specificity., Conclusions and Relevance: This is the first self-assessment tool designed to assess an individual's risk for ear disease. Our preliminary results demonstrate a high sensitivity to disease detection. A further validated and refined version of this questionnaire may serve as an efficacious tool for improving access to hearing health care while minimizing the risk for missed ear diseases.